Doctors use antipsychotics to calm 'challenging behaviour'

Antipsychotic drugs may not address the root of the problem (Image: BSIP, Laurent/Science Photo Library)

Doctors are resorting to powerful psychotropic drugs, such as antipsychotics and antidepressants, to calm patients with intellectual disabilities – even if they don’t have a history of mental illness. The new study puts figures on a practice that has long been suspected.

“Sedating people may dampen the challenging behaviour, but won’t identify the source of the frustration,” says Rory Sheehan of University College London.

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Sheehan and his colleagues collected data from 571 doctors’ surgeries in the UK over five years. They identified 33,016 patients with intellectual disability, defined as having an IQ of 70 or below, plus a range of difficulties coping with the routines of daily life. Of these people, 63 per cent had been prescribed some kind of psychotropic drug by the end of the study, even though just 34 per cent of the whole group had been diagnosed with a mental illness.

The study found that 9135 people had been given antipsychotic drugs. This is despite 71 per cent of them not having a record of the kind of severe mental illness, such as bipolar disorder or schizophrenia, for which these drugs are usually prescribed. Those with a record of “challenging behaviour” were more than twice as likely as those without to receive the medication.

“It’s possible the doctors are prescribing them to manage the behaviour, but there’s very little evidence that these drugs work in these situations,” says Sheehan. A person may be banging their head on the table because they have an ear infection, for example, in which case an antipsychotic drug wouldn’t solve the problem.

Chemical restraint

“Fundamental changes must be delivered, addressing a culture of ‘chemical restraint’ and replacing it with individualised behaviour support,” says Viv Cooper at the UK Challenging Behaviour Foundation.

“We’ve heard from families time and time again about their loved ones being given high levels of antipsychotic medicine, often for years” says Dan Scorer at Mencap. “In many cases they report serious side effects and no evidence the medication helps.”

However, Sheehan points out that managing outbursts and aggression is far from simple. “It’s no accident that it’s called ‘challenging behaviour’,” he says. “It challenges services, families and everyone involved in these people’s care, and it’s not easy to manage.”

Sheehan says that sometimes, doctors may prescribe calming drugs at the request of carers who fear that patients may otherwise damage themselves or may get evicted from their residence. “It’s not easy, but we hope that our study will promote thinking about alternative solutions instead of prescribing medications for mental illness when there are other likely causes.”